Regularly monitor neuropsychiatric symptoms in Parkinson’s disease and adjust treatment as necessary

  • Adis Medical Writers
Disease Management


Neuropsychiatric disorders are frequent in Parkinson’s disease (PD), but may be difficult to identify as they are closely related to other aspects of PD, such as motor impairment and non-motor fluctuations. While integral to PD treatment, dopaminergic therapies may contribute significantly to neuropsychiatric symptoms. Treatments in PD should be constantly reviewed and balanced, such as by adjusting doses appropriately, to minimize neuropsychiatric issues among other adverse events.


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Conflict of interest

The article was adapted from CNS Drugs 2018;32(7):621–35 [1] by employees of Adis/Springer, who are responsible for the article content and declare no conflicts of interest.


The preparation of this review was not supported by any external funding.


  1. 1.
    Mueller C, Rajkumar AP, Wan YM, et al. Assessment and management of neuropsychiatric symptoms in Parkinson’s disease. CNS Drugs. 2018;32(7):621–35.CrossRefGoogle Scholar
  2. 2.
    Hely MA, Morris JGL, Reid WGJ, et al. Sydney multicenter study of Parkinson’s disease: non-l-dopa-responsive problems dominate at 15 years. Mov Disord. 2005;20(2):190–9.CrossRefGoogle Scholar
  3. 3.
    Marsh L. Depression and Parkinson’s disease: current knowledge. Curr Neurol Neurosci Rep. 2013;13(12):409.CrossRefGoogle Scholar
  4. 4.
    Cooney JW, Stacy M. Neuropsychiatric issues in Parkinson’s disease. Curr Neurol Neurosci Rep. 2016;16(5):49.CrossRefGoogle Scholar
  5. 5.
    Ballard C, Ziabreva I, Perry R, et al. Differences in neuropathologic characteristics across the Lewy body dementia spectrum. Neurology. 2006;67(11):1931–4.CrossRefGoogle Scholar
  6. 6.
    Jaakkola E, Joutsa J, Makinen E, et al. Ventral striatal dopaminergic defect is associated with hallucinations in Parkinson’s disease. Eur J Neurol. 2017;24(11):1341–7.CrossRefGoogle Scholar
  7. 7.
    Ballanger B, Strafella AP, van Eimeren T, et al. Serotonin 2A receptors and visual hallucinations in Parkinson disease. Arch Neurol. 2010;67(4):416–21.CrossRefGoogle Scholar
  8. 8.
    Collerton D, Perry E, McKeith I. Why people see things that are not there: a novel perception and attention deficit model for recurrent complex visual hallucinations. Behav Brain Sci. 2005;28(6):737–57.Google Scholar
  9. 9.
    Kalia LV, Lang AE. Parkinson’s disease. Lancet. 2015;386(9996):896–912.CrossRefGoogle Scholar
  10. 10.
    Storch A, Schneider CB, Wolz M, et al. Nonmotor fluctuations in Parkinson disease: severity and correlation with motor complications. Neurology. 2013;80(9):800–9.CrossRefGoogle Scholar
  11. 11.
    Ravina B, Marder K, Fernandez HH, et al. Diagnostic criteria for psychosis in Parkinson’s disease: report of an NINDS, NIMH work group. Mov Disord. 2007;22(8):1061–8.CrossRefGoogle Scholar
  12. 12.
    Telenius EW, Engedal K, Bergland A. Effect of a high-intensity exercise program on physical function and mental health in nursing home residents with dementia: an assessor blinded randomized controlled trial. PLoS One. 2015;10(5):e0126102.CrossRefGoogle Scholar
  13. 13.
    Politis AM, Vozzella S, Mayer LS, et al. A randomized, controlled, clinical trial of activity therapy for apathy in patients with dementia residing in long-term care. Int J Geriatr Psychiatry. 2004;19(11):1087–94.CrossRefGoogle Scholar
  14. 14.
    Holmes C, Knights A, Dean C, et al. Keep music live: music and the alleviation of apathy in dementia subjects. Int Psychogeriatr. 2006;18(4):623–30.CrossRefGoogle Scholar
  15. 15.
    Weintraub D, Koester J, Potenza MN, et al. Impulse control disorders in Parkinson disease: a cross-sectional study of 3090 patients. Arch Neurol. 2010;67(5):589–95.CrossRefGoogle Scholar
  16. 16.
    Timmer MHM, van Beek M, Bloem BR, et al. What a neurologist should know about depression in Parkinson’s disease. Pract Neurol. 2017;17(5):359–68.CrossRefGoogle Scholar
  17. 17.
    Parkinson’s disease in adults. NICE guideline 71. London: National Institute for Health and Care Excellence; 2017.Google Scholar
  18. 18.
    Cummings J, Isaacson S, Mills R, et al. Pimavanserin for patients with Parkinson’s disease psychosis: a randomised, placebo-controlled phase 3 trial. Lancet. 2014;383(9916):533–40.CrossRefGoogle Scholar
  19. 19.
    van Laar T, Postma AG, Drent M. Continuous subcutaneous infusion of apomorphine can be used safely in patients with Parkinson’s disease and pre-existing visual hallucination. Parkinsonism Relat Disord. 2010;16(1):71–2.CrossRefGoogle Scholar
  20. 20.
    Wolters EC, Hurwitz TA, Mak E, et al. Clozapine in the treatment of parkinsonian patients with dopaminomimetic psychosis. Neurology. 1990;40(5):832–4.CrossRefGoogle Scholar
  21. 21.
    Parkinson Study Group. Low-dose clozapine for the treatment of drug-induced psychosis in Parkinson’s disease. N Engl J Med. 1999;340(10):757–63.CrossRefGoogle Scholar
  22. 22.
    Burn D, Emre M, McKeith I, et al. Effects of rivastigmine in patients with and without visual hallucinations in dementia associated with Parkinson’s disease. Mov Disord Off J Mov Disord Soc. 2006;21(11):1899–907.CrossRefGoogle Scholar
  23. 23.
    Bomasang-Layno E, Fadlon I, Murray AN, et al. Antidepressive treatments for Parkinson’s disease: a systematic review and meta-analysis. Parkinsonism Relat Disord. 2015;21(8):833–42.CrossRefGoogle Scholar
  24. 24.
    Aarsland D, Marsh L, Schrag A. Neuropsychiatric symptoms in Parkinson’s disease. Mov Disord. 2009;24(15):2175–86.CrossRefGoogle Scholar
  25. 25.
    Deuschl G, Fogel W, Hahne M, et al. Deep-brain stimulation for Parkinson’s disease. J Neurol. 2002;249(Suppl 3):III/36–9.Google Scholar
  26. 26.
    Starkstein SE. Apathy in Parkinson’s disease: diagnostic and etiological dilemmas. Mov Disord. 2012;27(2):174–8.CrossRefGoogle Scholar
  27. 27.
    Kirsch-Darrow L, Zahodne LB, Marsiske M, et al. The trajectory of apathy after deep brain stimulation: from pre-surgery to 6 months post-surgery in Parkinson’s disease. Parkinsonism Relat Disord. 2011;17(3):182–8.CrossRefGoogle Scholar
  28. 28.
    Borisovskaya A, Bryson WC, Buchholz J, et al. Electroconvulsive therapy for depression in Parkinson’s disease: systematic review of evidence and recommendations. Neurodegener Dis Manag. 2016;6(2):161–76.CrossRefGoogle Scholar
  29. 29.
    Oguro H, Nakagawa T, Mitaki S, et al. Randomized trial of repetitive transcranial magnetic stimulation for apathy and depression in Parkinson’s disease. J Neurol Neurophysiol. 2014;5(5):242.Google Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.SpringerAucklandNew Zealand

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